Clinical evaluation and endoscopic classification of gastrointestinal findings in 220 dogs with brachicephalic syndrome.

The pathophysiological correlation between the brachycephalic syndrome and the gastrointestinal system has been known for many years. Different grading schemes have been proposed for digestive signs (DS); however, an endoscopic systematic classification is lacking. The aims of this retrospective study were to describe DS; to classify endoscopic gastrointestinal findings (EGF); and to evaluate possible associations among clinical data, endoscopic respiratory findings (ERF) and EGF at diagnosis and after surgery. Information gleaned from the medical records included signalment, body weight, body condition score (BCS), DS, respiratory signs (RS), EGF, ERF, and DS/RS 1 and 6 months after surgery. DS and RS were classified according to the Poncet classification. Video documentation was reviewed to assign a score to each EGF (1 present/0 absent). A total EGF score (0-8) was obtained by the sum of each EGF score. The following EGF were evaluated before intubation (sternal recumbency): alterations compatible with distal esophagitis, cardial atony and sliding hiatal ernia. The following EGF were evaluated after intubation (left lateral recumbency): alterations compatible with gastric and duodenal inflammation and lymphangectasia, mucosal hyperplasia of the antrum and pylorus. In addition, esophageal dilatation/deviation, and presence of food in the stomach were recorded. A total of 220 brachycephalic dogs were included: 176 French Bouledogues, 22 English Bulldogs, 18 Pugs, 4 other brachycephalic breeds. The median age was 24 months (range 2-120), the median body weight was 12.2 kg (range 5-40), the median BCS was 3 (range 2-5). Of the 150 dogs with DS, regurgitation was the most prevalent sign (94 dogs), followed by vomiting (27 dogs), nausea (25 dogs) and diarrhea (11 dogs). All dogs but 11 showed EGF. Esophageal dilatation/deviation, distal esophagitis, cardial atony, axial hiatal ernia, gastritis, mucosal hyperplasia of the antrum and pylorus, food in the stomach, duodenitis and lymphangectasia were found in 166, 167, 62, 51, 150, 40, 77, 47, 130 and 60 dogs, respectively. Total EGF score ≥ 5 was assigned to 59 dogs. A tendency for dogs with lower BCS to have higher total EGF scores was found (p=0.05586). Significant associations were found between total EGF scores and DS/RS both at diagnosis and follow-up, total EGF scores and severity of ERF, severity of distal esophagitis and severity of laryngeal granuloma. Based on these results, a standardized endoscopic evaluation of the digestive system could be a useful additional tool to define severity and prognosis of brachycephalic syndrome.